The Impact of Post-Stroke Depressive Symptoms on Cognitive Performance in Women and in Men: A 4 Month Prospective Study.

Background: Depressive symptoms have been associated with cognitive impairment after stroke, and women may be specifically affected. Objective: The aim of this study was to investigate gender-specific characteristics in the relationship between changes in depression severity and changes in cognitive performance after stroke. Methods: We prospectively evaluated 73 patients without a previous history of depression in the first and fourth months after a first ischemic stroke. The severity of depressive symptoms was assessed using the 31-item version of the Hamilton Rating Scale for Depression, and executive function, attention, working memory, and verbal fluency were assessed using a neuropsychological battery. Results: We included 46 (63.0%) men and 27 (36.9%) women, with mean ages of 55.2 (SD ± 15.1) and 46.8 (SD ± 14.7) years, respectively. We found significant improvement in the digit span forward and Stroop dots from month 1 to month 4 post stroke for both men and women. Women, but not men, presented a correlation between changes in phonemic verbal fluency and changes in the 31-item version of the Hamilton Rating Scale for Depression scores. Improvement in depression was correlated with improvement in verbal fluency, and worsening in depression was correlated with worsening in verbal fluency. Conclusions: Our results suggest that women might be more vulnerable to the relationship between depressive symptoms and cognitive performance, and improvement of depression may be necessary for women's improvement in phonemic verbal fluency from the first to the fourth month after a stroke. We did not adjust the results for multiple comparisons. Thus, our findings might be considered preliminary, and confirmatory studies, also focusing on specific characteristics of women that could explain these differences, are warranted.

The influence of depressive symptoms on quality of life after stroke: a prospective study.

BACKGROUND: Poststroke depressive symptoms have prospectively predicted impairment of health-related quality of life (HRQOL). However, it is not known whether such predictive effect is independent of HRQOL at 1 month after stroke. This study aimed to investigate the impact of depressive symptoms at 1 and 3 months after stroke on the 3-month poststroke HRQOL and to investigate the influence of the HRQOL measured at 1 month after stroke on these relationships. METHODS: We prospectively evaluated 67 patients at 1 and 3 months after a first-ever ischemic stroke from 106 eligible patients who have been consecutively admitted to the neurology ward of a teaching hospital. A psychiatrist assessed the presence of depressive symptoms using the 31-item version of the Hamilton Rating Scale for Depression and the HRQOL was assessed with the 36-item Short-Form Health Survey from the Medical Outcomes Study. We used linear regression to measure the impact of depressive symptoms, HRQOL at 1 month, and potential confounders on HRQOL at 3 months. RESULTS: We found an association between depressive symptoms at 1 month and HRQOL at 3 months after the stroke; however, this association was not significant when adjusting for the 1 month poststroke HRQOL. Depressive symptoms at 3 months were associated with HRQOL at 3 months after stroke, independently of the poststroke HRQOL at 1 month and potential confounders. CONCLUSIONS: Current depressive symptoms at 3 months are important for HRQOL at 3 months after stroke; however, regarding the prospective prediction, HRQOL at 1 month is the most relevant factor.

Prevalência de depressão em mulheres idosas com fratura de quadril / Prevalence of depression in older women with hip fracture

CONTEXTO: A fratura de quadril possui elevada prevalência, principalmente em mulheres idosas. A depressão possui elevada prevalência nas mulheres e dados da literatura sugerem a existência de uma associação entre depressão e risco de fratura de quadril. Entretanto, não encontramos estudos brasileiros investigando especificamente esse tópico. OBJETIVOS: Investigar, em mulheres idosas, a prevalência de episódio depressivo maior precedendo a fratura de quadril e comparar com a prevalência de depressão em um grupo controle. MÉTODOS: Foram avaliadas 65 mulheres idosas, sendo 30 com fratura de quadril e 35 sem fratura de quadril. Para avaliar a depressão, utilizaram-se a Entrevista Clínica Estruturada para DSM-IV (SCID) e a Escala de Hamilton para Depressão na versão de 31 itens (HAM-D-31); para a avaliação do estado cognitivo, utilizou-se o Mini-Exame do Estado Mental (Mini Mental State Examination " MMSE). RESULTADOS: As pacientes com fratura de quadril apresentaram uma tendência para maior prevalência de história de episódio depressivo maior (p = 0,08) e menor pontuação para o MMSE. CONCLUSÕES: Neste estudo preliminar, encontrou-se uma tendência para maior prevalência de depressão em mulheres idosas com fratura de quadril. Estudos multicêntricos são recomendados para investigar essa possível associação na população brasileira.

BACKGROUND: Hip fracture has a high prevalence, especially among older women. Depression is common among females and data have suggested the existence of an association between depression and risk of hip fracture. However, we could not find Brazilian studies focusing specifically this issue. OBJECTIVES: To investigate, in elderly women, the prevalence of major depressive episode previously to the hip fracture and compare with the prevalence of depression in a control group. METHODS: We evaluated 65 elderly women, 30 with hip fracture and 35 without a hip fracture. To evaluate the depression we used the Structured Clinical interview for DSM-IV (SCID) and the 31-item version of the Hamilton Rating Scale for Depression (HAM-D-31), and to evaluate the cognitive state we used the Mini Mental State Examination (MMSE). RESULTS: Patients with hip fracture showed a trend for increased prevalence of previous major depressive episode (p = 0.08) and lower scores on the MMSE. DISCUSSION: In this preliminary study we found a trend for increased prevalence of depression in elderly women with hip fracture. Multicenter studies are warranted to investigate this possible association in the Brazilian population.

Depressão pós-AVC: aspectos psicológicos, neuropsicológicos, eixo HHA, correlato neuroanatômico e tratamento: [revisão] / Post-stroke depression: psychological, neuropsychological, HHA axis, localization of stroke aspects and treatment: [review]

CONTEXTO: A depressão pós-AVC (DPAVC) possui uma prevalência elevada. Apesar disso, ela é pouco detectada e tratada. Muitos fatores de risco e repercussões negativas na recuperação dos pacientes estão associados à DPAVC. OBJETIVO: Revisar alguns aspectos da DPAVC como: qualidade de vida, prejuízos cognitivos, eixo HHA, localização do AVC e tratamento. MÉTODOS: Pesquisa dos últimos 10 anos da base de dados MedLine/PubMed usando as palavras-chave post-stroke depression, stroke, quality of life, hypercortisolism, cogntitive dysfunction e treatment. RESULTADOS: A prevalência de DPAVC é de 23 por cento a 60 por cento. Há poucos estudos sobre a incidência de DPAVC. A DPAVC está associada a pior prognóstico e evolução, agravo das disfunções cognitivas e redução da qualidade de vida. O hipercortisolismo está associado à DPAVC que ocorre tardiamente ao AVC. AVC em gânglios da base, região frontal esquerda e estruturas do circuito prefrontosubcortical está relacionado à frequência e à gravidade da DPAVC. CONCLUSÕES: É necessário melhoria na metodologia dos estudos para maior esclarecimento sobre a fisiopatologia da incidência da DPAVC. Programas objetivando o aumento das taxas de detecção dos pacientes deprimidos se fazem necessários inclusive para a redução dos impactos negativos na recuperação desses pacientes.

BACKGROUND: The prevalence of post-stroke depression (PSD) is elevated. Some risk factors and poor outcome have been associated with PSD. The treatment of PSD reduced the negative impact in patients recovery. Appart from these data the PSD has been under diagnosed and under treated. OBJECTIVE: Review some aspects such as quality of life, cognitive dysfunction, hypercortisolism, stroke localization and treatment of PSD. METHODS: MedLine/PubMed database search using the terms post-stroke depression, stroke, quality of life, hypercortisolism, cognitive dysfunction and treatment, published in MedLine in the last 10 years. RESULTS: PSD has a high rate of prevalence, from 23 percent to 60 percent. Few incidence rates are investigated. PSD is associated with poor outcome, increase of cognitive dysfunction and reduced quality of life. The hypercortisolism seems to be associated with PSD in the latter period of stroke. Stroke in the left frontal region, basal ganglia and some structures of prefrontosubcortical circuits have been related with frequency and severity of PSD. DISCUSSION: Some programs can be used to assist the medical care researcher with these patients in diagnosis and treatment of PSD. The research needs to be continued with clear methodological protocols in order to understand the physiopathology related to the incident PSD.